Telehealth visit for Orthopedic Specialist

[pjenack@gmail.com]

Looking for some education as to what is required documentation for a f/u appointment for an orthopedic issue. My Provider documents the initial greeting setup with place, agree to visit by phone, time on call, etc. The issue I'm having is knowing if the telehealth visit meets guidelines to bill for a telehealth visit or is just a Provider making a call to discuss results, and not billable.

For example: if the phone visit is to discuss MRI results and PT is ordered, with a f/u appointment scheduled in office when PT is completed.

Thank you
Paula

 

[amyjph]

https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims#telehealth-codes-covered-by-medicare

https://www.cms.gov/files/document/mln901705-telehealth-remote-monitoring.pdf

https://telehealth.hhs.gov/providers/best-practice-guides

https://www.cms.gov/files/document/telehealth-faq-updated-02-26-2026.pdf

https://www.kzanow.com/alerts/medicare-telehealth-extended

https://www.kzanow.com/telehealth-solutions-center?rq=phone%20call

Questions to ask yourself: Is this audio-only telephone (a.k.a. synchronous audio-only)? If so, what code would you bill (can depend on health plan being billed)? What POS & modifier would it require? Did the practice already take credit for the order, review, performance of and interpretation of the MRI within the prior E/M/office visit?

Read the CPT guidelines at the beginning of the Telemedicine Services section in CPT. There is a lot of info here but specifically, "Telemedicine services are not used to report routine telecommunications related to a previous encounter (e.g.; to communicate laboratory results)."

 

[quiana.mitchell@att.net]

Honestly, coding telehealth ortho visits can be such a headache since payers keep changing their rules on modifiers and place-of-service codes. In my experience, double-checking whether it's a true video consultation versus a quick phone check-in saves us from endless claim denials later on.